Provider Demographics
NPI:1619678612
Name:FLOOD, MARY KATHRYN (DNP)
Entity Type:Individual
Prefix:
First Name:MARY KATHRYN
Middle Name:
Last Name:FLOOD
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 NUECES ST APT 2302
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-4268
Mailing Address - Country:US
Mailing Address - Phone:815-954-3675
Mailing Address - Fax:
Practice Address - Street 1:9835 N LAKE CREEK PKWY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-6210
Practice Address - Country:US
Practice Address - Phone:815-954-3675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1110091363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics